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M � t _ ONSITE ",ANASTEWATER TREATMENT SYSTEM PERMIT SAN JOA01.11N COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT ---___.y- CALL(/29J9 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM ?ATE ISSUED JOB ADDRESSAl 3 aS /�� /�YJ CITY/ZIP-_ C/11C.¢_�GfA Q CROSS STREET _ oriye -_ APN� - 1�t7� PARCEL SIZE CJ 1 c: OWNER NAME. C}I✓I�1_ ��K - —� � PHONE- OWNER ADDRESS _ CITY/STATE/ZIP CONTRACTOR PHONE CONTRACTOR ADDRESS -__ �J a� CITY/STATE/ZIP MC/I�fl _- — LICENSE f1IIC-42 MIC-36 OTIIEfd— - f11UMBER0 (0 &-i-i_1-EXPIRATIONDATE_-)"t�_ ----------- --- 1A/ATER TABLE DEPTH: % O ft GEOGRAPHICAL INFORMATION: Coordinates iC l -Ll PERC TEST # i BUILDING PERMIT�# LAND USE APPLICATION# -------1 �` ---- TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION t-1 ENGINEER DESIGNED/ALTERNATIVE I REPLACEMENT 11 OUT-OF-SERVICE SEPTIC SYSTEM a DESTRUCTION _ INSTALLATION MILL SERVE: — tESIDENCE I-1 COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS:_ '�. NUMBER OF BEDROOMS: _ JMBER OF EMPLOYEES: Lbw SEPTIC TANK TYPE/MI-G _ CAPACITY 'S gal #OF COMPARTMENTS 01 GREASE TRAP TYPE/MFG __- CAPACITY _ gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL Q�-- ft FOI INDATION�� — ft PROPERTY LINE ft LIFT STATION SIZE TYPE OF PUMP Q PKG TX PLANT 1-7: SAtQ OIL SEPARATOR.(ENCLOSED SY. TEM) -- -- �,��• V{S Nod l i I �l LEACH LINES 1.1 LEACHING CHAMBERS 11 OF DNL6_—._-- LENGTH OF UNES it DISTANCE TO NEAREST WELL_ ft FOUNDATION If PROPERTY LINE ft 13 FILTER SED WIDTH ft LENGTH _ ft DEPTH ft DISTANCE TO NEAREST WELL fit roUNDATION _ - ft PROPERTY LINE ft �7 MOUNDED VVIDTH ft LENGTH ft DEPTH ft ( DISTANCE.To NEAREST WELL ft FOUNDATION — fi. PROPERTY LINE_ ft WIDTH oLr ft LENGTH t It DE=PTH , ft DISTANCE TO NEAREST WELL l 5'n It FOUNDATION J01 ft PROPERTY LINE 7 S It 13 DISPOSAL PONDS WIDTH ft LENGTH_ ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft l3 SEEPAGE PITS NUMBER_ WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. its MM(IM 46 �fi�(9�s ADVANCE NO T IC RLE-:UERED FOR INSPECTIONS - PLF-:AS CALL (. )95,-1-7697 SIGNED A TITLE C—QYI&t C-*`&` DATE , I C DEPARTMEAJT USE ON/_ Application Accepted By — Date 1^ Area Employee ID-#- 'a— Final Q.Final Inspection By _ _ Dafie2 ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of/3 Ft: :..+1nip Soil Character: _ COMMENTS PE SC� Received Chec Amoy-Int Permitl Code INFO By_ Date --I- — Invoice# Permit ID# f Remiited Service Rec rJ�st# ,12_O I ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/1411 R